31.1 Introduction
Psychological testing is a single part of the total assessment process. Normally psychological tests are the domain of clinical psychologists who receive many hours of theoretical and practical education in psychometrics. This chapter is not intended as a tutorial in psychological testing or assessment. It aims to acquaint the clinician with some of the more commonly used tests and their purposes. Major psychological testing, such as IQ testing and achievement testing, require clinical or educational psychologists to administer as they require skillful administration and an in-depth knowledge of how to place the results of these tests into proper context. But there are rating scales that can, and often should, be used by clinicians in order to augment other assessment findings. Hence this chapter is also intended to familiarize the practitioner with the utility of some of these tests and rating scales for their own practice, both as part of assessment and as part of ongoing evaluation of patient progress throughout the treatment process.
The goal of testing is to develop a working image or model of the patient. This model/image is a set of hypotheses about the person and his or her life situation or situations. Based on multiple sources of data that include history, interviewing, and testing, clinicians try to develop as accurate a picture of patients as possible prior to considering various plans for intervening and working with them.
31.2 Major Assessment Approaches
All assessment in the psychological domain is assessment of behavior and/or cognitive or affective states. These involve verbal reports of thoughts and feelings, or the checking of answers on a questionnaire, as well as evaluation of motor performance or actions that are observable. There are three broad techniques involved in personality assessment, behavioral, objective and projective. A comparison of these is contained in Table 31.1.
Table 31.1 Assessment approaches.
31.3 Functional Analysis of Behavior
Functional (behavioral) assessment (FBA) is a systematic process for gathering information in order to determine the relationships between a person’s problem behavior and aspects of the environment (see Chapter 32). Through FBA, it is possible to identify specific events that predict and maintain behavior and design a plan that effectively addresses those variables. FBA methods can, and should, vary across circumstances, but typically include record reviews, interviews, and direct observation. FBA methods range from highly precise and systematic to relatively informal. Particular tools and strategies should be selected based on the circumstances, individuals involved, and goals of intervention.
The goal of FBA, regardless of which methods are used, is to answer certain questions.
1. Under what circumstances is the behavior most/least likely to occur (e.g., when, where, with whom)?
2. What outcomes does the behavior produce (i.e., what does the person get or avoid through his or her behavior)?
To answer these questions, the information gathered must be analyzed and summarized. Hypothesis (or summary) statements describe the specific patterns identified through the FBA and, if supported by the data, provide a foundation for intervention. A hypothesis statement must describe the behavior and the conditions under which it occurs. Interventions are designed accordingly, and if the hypothesis is not supported the assessment is conducted again with alternate hypotheses generated from data that may have been overlooked in the first assessment. There are tools available in the public domain that can be downloaded from the internet; see http://www.lessons4all.org/downloads/FAST.pdf. Also, Table 31.2 describes three methods of conducting a functional analysis and the sources clinicians might employ. Table 31.3 lists some commonly used psychiatric rating scales.
Table 31.2 Functional analysis of behavior.
| Method | Sample Sources |
| Direct observation | Observations conducted across a variety of settings, times, circumstances and ideally by more than one person Yield frequency measures across conditions |
| Structured interviews | Family and teachers, other service providers, people who know the patient well and have observed them across a variety of settings |
| Record review | Diagnostic and medical records, history, incident reports, previous treatment plans and IEPs from educational settings |
Table 31.3 Common psychiatric rating scales.
| Type of Scale | Examples |
| Observer rating | Mini Mental State Examination (MMSE) |
| Brief Psychiatric Rating Scale | |
| Positive and Negative Syndrome Scale | |
| Hamilton Depression Inventory | |
| Hamilton Anxiety Scale | |
| Yale–Brown Obsessive Compulsive Scale | |
| Self rating | Major Depression Inventory |
| Beck Depression Inventory | |
| Hopkins Symptom Checklist | |
| Hospital Anxiety Depression Scale | |
| Side-effects | Abnormal Involuntary Movement Scale |
| Extrapyramidal symptom rating scale | |
| Global assessment of functioning | Covers Axis V of the DSM |
31.4.1 Intelligence Testing
There are numerous controversies regarding the definition, use, and interpretation of the various measures of intelligence, and theories of intelligence abound. Traditionally intelligence is quantified as the global capacity of the individual to act purposefully, to think rationally, and to deal effectively with the environment.
An intelligence quotient (IQ) is a score derived from a set of standardized tests developed to measure a person’s cognitive abilities (“intelligence”) in relation to his or her age group. Although the intelligence quotient itself seems subject to little variation over a person’s lifetime, it is worth keeping in mind that intelligence is neither unitary, nor fixed. IQ is generally predictive for academic, social, and occupational success, but not in all instances. Its most useful quality is a measurement of an individual’s strengths and weaknesses in certain areas of ability. The two most commonly used in the United States are the Wechsler series and the Stanford–Binet. Both have been criticized for an over-emphasis on verbal skills and for being culturally biased. These instruments are described below.
31.4.1.1 Wechsler Preschool and Primary Scale of Intelligence – Revised
The WPPSI-R can be used for children ranging in age from 3 to 7.25 years. Though separate and distinct from the WISC-III (discussed below), it is similar in form and content. The WPPSI-R is considered a downward extension of the WISC-III. These two tests overlap between the ages of 6 and 7.25 years.
The WPPSI-R has a mean of 100 and standard deviation of 15, with scaled scores for each subtest having a mean of 10 and a standard deviation of 3. It contains 12 subtests organized into one of two major areas. The Verbal Scale includes information, similarities, arithmetic, vocabulary, comprehension, and sentences (optional) subtests. The Performance Scale includes picture completion, geometric design, block design, mazes, object assembly, and animal pegs (optional) subtests. The WPPSI-R contains nine subtests similar to those included in the WISC-III (information, vocabulary, arithmetic, similarities, comprehension, picture completion, mazes, block design, and object assembly) and three unique subtests (sentences, animal Pegs, and geometric design). Three separate IQ scores can be obtained: Verbal Scale IQ, Performance Scale IQ, and Full Scale IQ.
The WPPSI-R was standardized on 1700 children equally divided by gender and stratified to match the 1986 US census data. This instrument cannot be used with severely disabled children (IQs below 40) and, with younger children, may need to be administered over two sessions owing to the length of time required to complete the assessment.
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